Hypertension in Ulaanbaatar – in pictures

Hypertension in Ulaanbaatar – in pictures

World Hypertension Day on 17 May aims to increase the awareness of the condition (high blood pressure), a silent killer on the rise. British global health physician-photographer Dr Alexander Kumar shares images and stories from an assignment to document Better Hearts Better Cities, a new urban health initiative by the Novartis Foundation to help overcome the burden of the illness in Ulaanbaatar, Mongolia

The burden of non-communicable diseases is increasing globally, accounting for 70% of deaths. These include cardiovascular disease (responsible for 17.7 million deaths annually), cancer (8.8 million), respiratory diseases (3.9 million), and diabetes (1.6 million). Worldwide, hypertension (raised blood pressure) – a chronic, debilitating non-communicable disease – is estimated to cause around 10 million deaths (about 12.8% of the total of all deaths) and is a leading cause of death in Mongolia.

More than 1.5 million people, half Mongolia’s total population, live in the capital, Ulaanbaatar. Many herders and nomads moving to the city for economic reasons settle in Ger tents in the socioeconomically deprived peripheries of the city known as Ger districts.

Ulaanbaatar is increasingly suffering from traffic congestion. Measures are in place to restrict the number of vehicles on the road, but air pollution is worsening year-by-year and has an impact on health. A growing body of evidence links air pollution to ill health and the development of non-communicable diseases.

Access to the essentials for healthy living including water and healthcare, is a struggle for those living in the Ger districts. Continuing population growth due to migration to the city is creating new environmental challenges for the area, including air and water pollution, flood damage and water supply shortages.

Living in a Ger district, Togmoddorj is a 69-year-old mechanic was left unable to work after suffering a stroke 10 years ago, caused by unknown and untreated hypertension. His wife, Davaajav, has been his full-time carer, as well as being the sole money earner and suffers from health issues herself.

Milk from cattle, camels, horses, yaks, goats and sheep is an important part of the Mongolian diet. Suutei tsai (perched here on the stove inside a family’s Ger) is a traditional drink made from equal parts water and milk, a tablespoon of green tea and a teaspoon of salt. Drunk as part of Mongolian custom and culture, the tea is linked to high blood pressure.

Dr Namkhaidorj, born in the Mongolian provinces, is one of Ulaanbaatar’s most experienced cardiologists, having worked in China and South Korea. Using telemedicine services, he reviews patients thousands of kilometres away, helping to deal with the rising tide of cardiovascular disease in the country.

Unlike her peers, Munkhtsetseg, a medical student from Arkhangai province, is fascinated by Mongolian traditional medicine and studies it in her spare time while at medical school in Ulaanbaatar. She believes ‘everything we are comes from nature, especially in Mongolia, where we have an old history and tradition, but with new treatments waiting to be discovered traditional medicine holds great potential for hypertension and other diseases’.